Investigations of Esophagoenteral Anastomoses by Manometry and pH-metry and Evaluation of Antireflux Reconstructions
There are more than 50 techniques applicable for preventing reflux in esophagoenteral anastomoses after total gastrectomy [1–3, 5]. However, a considerable number of patients with a so-called alkaline reflux result from most of the methods. More complicated procedures may also cause an insufficiency of two or more anastomoses (Table 1). Jejunoplication according to Siewert-Peiper [6, 7] or according to Schreiber  is said to fulfill the requirements: (1) prevention of reflux esophagitis, (2) inhibition of dumping; reservoir, and (3) safety and simplicity of technique. Of 48 patients with carcinoma (Fig. 1) operated on by gastrectomy, 29 were reexamined after 1 year with X-ray (special contrast medium), manometry (rapid pull-through method, three-point method), long-term pH-metry, endoscopy, and histology (Savary). Of these patients, two received an omega loop and six were reconstructed and modified according to Schreiber and 21 according to Siewert-Peiper. For three-point manometry, constant-flow perfusion was used with its pressure reservoir to ensure a valid reproduction of the pressure values. “Alkaline” reflux was defined to occur when a pH above 7 was recorded. Long-term pH-monitoring of the lower esophagus was established by a radiometer probe GK 282/C 5 cm above the anastomosis. Since there is only a small high-pressure zone in the site of anastomosis, it was established not only by manometry but also as the distance from the anastomosis to the incisors by endoscopy and/or radiologically. The patient was allowed to move freely in the upright and supine position. Severe reflux with a pH of more than 7.5 was reported as the percentage of the examination period. The number and duration of severe alkaline reflux episodes were also noted.
KeywordsTotal Gastrectomy Reflux Esophagitis Severe Reflux Abdominal Compression Pressure Reservoir
Unable to display preview. Download preview PDF.
- 7.Siewert JR, Peiper H-J, Wallat H (1974) Erste Erfahrungen mit der Ösophago-Jejunoplikatio. Bruns’ Beitr Klin Chir 221:343–354Google Scholar